1
|
Zimmerman A, Laitman A. Safe Management of Adverse Effects Associated with Prescription Opioids in the Palliative Care Population: A Narrative Review. J Clin Med 2024; 13:2746. [PMID: 38792289 PMCID: PMC11121850 DOI: 10.3390/jcm13102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
In the palliative care population, prescription opioids are often considered viable pain relief options. However, in this complex patient population, the adverse effects of opioid medications should be identified and managed without delay. Common adverse effects can include constipation, nausea, somnolence, dizziness, vomiting, and pruritus. Less common adverse effects can include potentially lethal respiratory depression and cardiovascular effects. Critical aspects of safe opioid prescribing are recognition of side effects and knowledge of effective management strategies; prompt management is necessary for uninterrupted pain relief. Most complications are managed with general approaches such as dose reduction, opioid rotation, alternate routes of administration, and symptomatic management. The only opioid-induced complication for which US Food and Drug Administration-approved treatments currently exist is constipation. Treating laxative-refractory opioid-induced constipation (OIC) with peripherally acting mu-opioid receptor antagonists (PAMORAs), which block gastrointestinal opioid receptors, can restore gastrointestinal motility and fluid secretion. This narrative review discusses key complications of prescription opioid treatment and their management in the palliative care setting.
Collapse
Affiliation(s)
| | - Adam Laitman
- Salix Pharmaceuticals, Bridgewater, NJ 08807, USA;
| |
Collapse
|
2
|
Samardžić M, Peršić M, Széchenyi A, Jozanović M, Pukleš I, Budetić M. Development of the New Sensor Based on Functionalized Carbon Nanomaterials for Promethazine Hydrochloride Determination. SENSORS (BASEL, SWITZERLAND) 2023; 23:2641. [PMID: 36904844 PMCID: PMC10007115 DOI: 10.3390/s23052641] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Promethazine hydrochloride (PM) is a widely used drug so its determination is important. Solid-contact potentiometric sensors could be an appropriate solution for that purpose due to their analytical properties. The aim of this research was to develop solid-contact sensor for potentiometric determination of PM. It had a liquid membrane containing hybrid sensing material based on functionalized carbon nanomaterials and PM ions. The membrane composition for the new PM sensor was optimized by varying different membrane plasticizers and the content of the sensing material. The plasticizer was selected based on calculations of Hansen solubility parameters (HSP) and experimental data. The best analytical performances were obtained using a sensor with 2-nitrophenyl phenyl ether (NPPE) as the plasticizer and 4% of the sensing material. It had a Nernstian slope (59.4 mV/decade of activity), a wide working range (6.2 × 10-7 M-5.0 × 10-3 M), a low limit of detection (1.5 × 10-7 M), fast response time (6 s), low signal drift (-1.2 mV/h), and good selectivity. The working pH range of the sensor was between 2 and 7. The new PM sensor was successfully used for accurate PM determination in a pure aqueous PM solution and pharmaceutical products. For that purpose, the Gran method and potentiometric titration were used.
Collapse
Affiliation(s)
- Mirela Samardžić
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, 31000 Osijek, Croatia
| | - Mateja Peršić
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, 31000 Osijek, Croatia
| | - Aleksandar Széchenyi
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, 31000 Osijek, Croatia
| | - Marija Jozanović
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, 31000 Osijek, Croatia
| | - Iva Pukleš
- Doctoral School of Chemistry, University of Pécs, Ifjúság útja, 7624 Pécs, Hungary
| | - Mateja Budetić
- Department of Chemistry, Josip Juraj Strossmayer University of Osijek, Cara Hadrijana 8/A, 31000 Osijek, Croatia
| |
Collapse
|
3
|
Raja DA, Shah MR, Malik MI. Polyethyleneimine stabilized silver nanoparticles as an efficient and selective colorimetric assay for promethazine. Anal Chim Acta 2022; 1223:340216. [DOI: 10.1016/j.aca.2022.340216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
|
4
|
You Y, Bai S, Ma Y, Liu C, Wang L. A Nanopipette Supported Oil/Water Interface Sensor for the Kinetics Analysis and Determination of Phenothiazine Derivatives. Electrochim Acta 2022. [DOI: 10.1016/j.electacta.2022.140568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
5
|
Nualdee K, Buain R, Janchawee B, Sukree W, Thammakhet-Buranachai C, Kanatharana P, Chaisiwamongkhol K, Prutipanlai S, Phonchai A. A stir bar sorptive extraction device coupled with a gas chromatography flame ionization detector for the determination of abused prescription drugs in lean cocktail samples. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2022; 14:2557-2568. [PMID: 35699255 DOI: 10.1039/d2ay00603k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A lean cocktail is a mixed drink for the non-medical use of prescription medications that has emerged in recent years as a drug of abuse and is related to drug-facilitated crimes. The determination of active ingredients in a lean cocktail is necessary for forensic investigations. This work presents an in-house developed stir bar sorptive extraction (SBSE) device with an XAD-2 adsorbent followed by analysis using GC-FID for the extraction and determination of the five main abused prescription drugs (diphenhydramine, tramadol, chlorpheniramine, dextromethorphan and promethazine) in lean cocktail samples. Under optimized conditions, the developed method provided linearity for 1.0-250 μg mL-1 of each of the five abused prescription drugs. The limits of detection and limits of quantitation were in the respective ranges of 0.25-0.5 μg mL-1 and 1.0-1.5 μg mL-1. The percentage of extraction was 85.0-94.9%. The intra-day and inter-day precisions were 1.2-14.4% RSD and 1.4-15.8% RSD, respectively. Good relative recoveries in the range of 86.7-110.3% and 88.5-107.9% were obtained when the proposed method was applied for extraction and analysis of abused prescription drugs in five lean cocktail samples. The developed method can be a useful tool for measuring the levels of abused prescription drugs in a lean cocktail and the data could also be used as evidence in a forensic investigation.
Collapse
Affiliation(s)
- Kamonwan Nualdee
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
| | - Ratchaneekorn Buain
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
| | - Benjamas Janchawee
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
| | - Warakorn Sukree
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Chongdee Thammakhet-Buranachai
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Proespichaya Kanatharana
- Center of Excellence for Trace Analysis and Biosensor, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Center of Excellence for Innovation in Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Korbua Chaisiwamongkhol
- School of Science, Mae Fah Luang University, Chiang Rai 57100, Thailand
- Center of Chemical Innovation for Sustainability (CIS), Mae Fah Luang University, Chiang Rai 57100, Thailand
| | - Sathaporn Prutipanlai
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
| | - Apichai Phonchai
- Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
- Forensic Science Innovation and Service Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| |
Collapse
|
6
|
Chiappini S, Schifano F, Corkery JM, Guirguis A. Beyond the 'purple drank': Study of promethazine abuse according to the European Medicines Agency adverse drug reaction reports. J Psychopharmacol 2021; 35:681-692. [PMID: 33427017 PMCID: PMC8278560 DOI: 10.1177/0269881120959615] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Promethazine is a medicinal product, available on its own or in combination with other ingredients including dextromethorphan, paracetamol and/or expectorants. Anecdotal reports have however indicated that promethazine may have a misuse potential, especially in adolescents. OBJECTIVE We here aimed at studying how this phenomenon has been reported to the European Monitoring Agency Adverse Drug Reactions database. METHODS After a formal request to the European Monitoring Agency, the promethazine-specific dataset has been studied, performing a descriptive analysis of misuse/abuse/dependence-related adverse drug reaction reports. The study was approved by the University of Hertfordshire (LMS/PGR/UH/03234). RESULTS The analysis of promethazine data showed increasing levels of misuse/abuse/ dependence issues over time (2003-2019). Out of a total number of 1543 cases of adverse drug reactions, the abuse/misuse/dependence-related cases reported were 557, with 'drug abuse' (300/557: 53.8%) and 'intentional product misuse' (117/557: 21.0%). being the most represented adverse drug reactions. A high number of fatalities were described (310/557: 55.6%), mostly recorded as 'drug toxicity/drug abuse' cases, with opiates/opioids having been the most commonly reported concomitant drugs used. CONCLUSION Anecdotal promethazine misuse/abuse reports have been confirmed by European Monitoring Agency data. Promethazine misuse/abuse appears to be an alarming issue, being associated with drug-related fatalities. Thus, healthcare professionals should be warned about a possible misuse of promethazine and be vigilant, as in some countries medicinal products containing promethazine can be purchased over the counter. Since promethazine is often available in association with opioids, its abuse may be considered a public health issue, with huge implications for clinical practice.
Collapse
Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK,Fabrizio Schifano, Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire AL10 9AB, UK.
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK
| | - Amira Guirguis
- Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Swansea, UK
| |
Collapse
|
7
|
Oyekan PJ, Gorton HC, Copeland CS. Antihistamine-related deaths in England: Are the high safety profiles of antihistamines leading to their unsafe use? Br J Clin Pharmacol 2021; 87:3978-3987. [PMID: 33729599 DOI: 10.1111/bcp.14819] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 01/26/2023] Open
Abstract
AIMS Antihistamines are routinely taken to control allergic reactions or sedation to induce sleep. There are, however, growing concerns regarding sedating antihistamine misuse. This research aims to evaluate deaths related to antihistamines in England occurring during 2000-2019. METHODS Cases reported to the National Programme on Substance Abuse Deaths from England occurring in 2000-2019 with antihistamine detections at postmortem were extracted for analysis. RESULTS In total, 1666 antihistamine postmortem detections were identified from 1537 cases. Sedating antihistamines available for purchase under pharmacist supervision but without need for a prescription (pharmacy-only medications) were present in a significant majority of cases (85.2%, P < .01). Despite an increasing trend for antihistamine-related deaths over time, the proportion of deaths where an antihistamine was implicated declined over the same period. Specific concerns with regards to the misuse of these pharmacy-only sedating antihistamines are raised with regards to the significant proportion of cases that were concluded as suicide (20.9%, P < .01), and the high prevalence of their use in combination with other central nervous system depressants (94.8% of cases). CONCLUSION This is the first report in over 40 years regarding antihistamine-related mortality from England. The rising trend in sedating antihistamine-related deaths may be contributed to by their increasing availability and the perceived negligible dangers associated with antihistamines, both from the general public and learned professionals. Awareness of the dangerous sedative properties that some antihistamines possess is, however, heightened in individuals deliberately seeking these effects. Urgent review of sedating antihistamines currently assigned under the pharmacy-only classification is needed to achieve antihistamine harm reduction.
Collapse
Affiliation(s)
- Princess J Oyekan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - Hayley C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Caroline S Copeland
- Institute of Pharmaceutical Sciences, King's College London, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
| |
Collapse
|
8
|
A portable optical colorimetric sensor for the determination of promethazine in lean cocktail and pharmaceutical doses. Microchem J 2020. [DOI: 10.1016/j.microc.2020.105519] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
9
|
Meyer JP, Culbert GJ, Azbel L, Bachireddy C, Kurmanalieva A, Rhodes T, Altice FL. A qualitative study of diphenhydramine injection in Kyrgyz prisons and implications for harm reduction. Harm Reduct J 2020; 17:86. [PMID: 33129341 PMCID: PMC7603760 DOI: 10.1186/s12954-020-00435-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/21/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To reduce opioid dependence and HIV transmission, Kyrgyzstan has introduced methadone maintenance therapy and needle/syringe programs into prisons. Illicit injection of diphenhydramine, an antihistamine branded as Dimedrol®, has been anecdotally reported as a potential challenge to harm reduction efforts in prisons but has not been studied systematically. METHODS We conducted qualitative interviews in Kyrgyz or Russian with prisoners (n = 49), former prisoners (n = 19), and stakeholders (n = 18), including prison administrators and prisoner advocates near Bishkek, Kyrgyzstan from October 2016 to September 2018. Interviews explored social-contextual factors influencing methadone utilization in prisons. Transcripts were coded by five researchers using content analysis. Dimedrol injection emerged as an important topic, prompting a dedicated analysis. RESULTS After drinking methadone, some people in prison inject crushed Dimedrol tablets, a non-prescription antihistamine that is banned but obtainable in prison, to achieve a state of euphoria. From the perspectives of the study participants, Dimedrol injection was associated with devastating physical and mental health consequences, including psychosis and skin infections. Moreover, the visible wounds of Dimedrol injecting contributed to the perception of methadone as a harmful drug and supporting preference for heroin over methadone. CONCLUSION Dimedrol injecting is a potentially serious threat to harm reduction and HIV prevention efforts in Kyrgyzstan and elsewhere in the Eastern European and Central Asian region and requires further investigation.
Collapse
Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
| | - Gabriel J Culbert
- Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Lyuba Azbel
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA
| | | | | | - Tim Rhodes
- The London School of Tropical Hygiene and Tropical Medicine, London, UK
| | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USA
| |
Collapse
|
10
|
Recognising post-traumatic stress disorder in cough syrup misuse. Lancet Psychiatry 2020; 7:737-738. [PMID: 32828158 DOI: 10.1016/s2215-0366(20)30345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022]
|
11
|
Phonchai A, Pinsrithong S, Janchawee B, Prutipanlai S, Botpiboon O, Keawpradub N. Simultaneous Determination of Abused Prescription Drugs by Simple Dilute-and-Shoot Gas Chromatography – Flame Ionization Detection (GC-FID). ANAL LETT 2020. [DOI: 10.1080/00032719.2020.1779738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Apichai Phonchai
- Department of Applied Science, Faculty of Science, Prince of Songkla University, Hat Yai, Thailand
| | | | - Benjamas Janchawee
- Department of Pharmacology, Prince of Songkla University, Hat Yai, Thailand
| | | | | | - Niwat Keawpradub
- Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand
| |
Collapse
|
12
|
Wooldridge LM, Kangas BD. An assay of drug-induced emesis in the squirrel monkey (Saimiri sciureus). J Med Primatol 2019; 48:236-243. [PMID: 30968960 DOI: 10.1111/jmp.12411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/07/2019] [Accepted: 03/10/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Emesis has significant evolutionary value as a defense mechanism against ingested toxins; however, it is also one of the most common adverse symptoms associated with both disease and medical treatments of disease. The development of improved antiemetic pharmacotherapies has been impeded by a shortage of animal models. METHODS The present studies characterized the responses of the squirrel monkey to pharmacologically diverse emetic drugs. Subjects were administered nicotine (0.032-0.56 mg/kg), lithium chloride (150-250 mg/kg), arecoline (0.01-0.32 mg/kg), or apomorphine (0.032-0.32 mg/kg) and observed for emesis and prodromal hypersalivation. RESULTS Nicotine rapidly produced emesis and hypersalivation. Lithium chloride produced emesis with a longer time course without dose-dependent hypersalivation. Arecoline produced hypersalivation but not emesis. Apomorphine failed to produce emesis or hypersalivation. CONCLUSIONS The squirrel monkey is sensitive to drug-induced emesis by a variety of pharmacological mechanisms and is well-positioned to examine antiemetic efficacy and clinically important side effects of candidate antiemetic pharmacotherapies.
Collapse
Affiliation(s)
| | - Brian D Kangas
- Behavioral Biology Program, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
13
|
Li BT, Moukaddam N, Parks KDL, Shah AA. When Treatment Turns to Addiction: Emerging Issues in Over-the-Counter and Prescription Drug Abuse. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180719-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
Eskander JP, Rapoport Y, Cornett E, Gennuso S, Franklin M, Kaye AD, Fox CJ. Does promethazine shorten the length of stay in the post anesthesia care unit? J Perioper Pract 2018; 28:194-198. [PMID: 29737920 DOI: 10.1177/1750458918776548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The combination of promethazine and opioids is known to have an opioid-sparing effect, thereby facilitating a reduction in total patient opioid consumption. In recent years, this practice has fallen out of favor in many healthcare facilities, except primarily in the post anesthesia care unit (PACU). The goal of this study was to highlight the potential of promethazine as a direct or indirect adjuvant medication in acute pain management. The present investigation was undertaken with a case series of adult female patients who underwent open total abdominal hysterectomies. Data from the PACU was reviewed with patients being separated into two groups. Group 1 received only intravenous opioids for acute pain management. Group 2 received a combination of intravenous opioids for acute pain management and intravenous promethazine for nausea and/or vomiting. Patients were discharged from the PACU with a modified Aldrete score of 9 or 10. The study showed that patients who received promethazine in addition to opioids were discharged from the PACU an average of 19.2 minutes earlier than those patients who received only opioids (p=0.003). The time to achieve modified Aldrete score of 9 or higher was more quickly achieved when open abdominal hysterectomy patients received promethazine in addition to opioids in the PACU. The study concluded that promethazine, in combination with opioids, could potentially decrease PACU stay postoperatively. Based on the present investigation, the prospect of using promethazine in other facets of pain management are intriguing and warrant future studies. Specifically, it may be worth investigating whether promethazine is truly an adjunct in combination with opioids and to determine if there are any other antihistamines or neuroleptics which may have similar clinical effects to promethazine.
Collapse
Affiliation(s)
- Jonathan P Eskander
- 1 Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Yury Rapoport
- 1 Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Elyse Cornett
- 1 Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sonja Gennuso
- 1 Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Michael Franklin
- 1 Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Alan D Kaye
- 2 Department of Anesthesiology, LSU School of Medicine New Orleans, 1542 Tulane Ave, Suite 659, New Orleans, LA, 70112, USA
| | - Charles J Fox
- 1 Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| |
Collapse
|
15
|
Abstract
Opioid dependence is an epidemic in the United States, and the percentage of pregnant women who are opioid dependent has increased dramatically in the last decade. Pain management, already a concern for intrapartum and postpartum care, is complicated in the context of opioid dependence. This clinical review surveys the literature on pain management in opioid-dependent pregnant women to summarize current consensus and evidence to guide clinical practice. Points of consensus for pain management in opioid-dependent pregnant women include continual opioid maintenance therapy throughout the pregnancy and the postpartum period; adequate management of acute pain; the contraindication of opioid agonist-antagonists for pain management; and the need for interdisciplinary teams using a multimodal approach to provide optimal care to opioid-dependent pregnant women.
Collapse
|
16
|
Weinstein ZM, Cheng DM, Quinn E, Hui D, Kim H, Gryczynski G, Samet JH. Psychoactive medications and disengagement from office based opioid treatment (obot) with buprenorphine. Drug Alcohol Depend 2017; 170:9-16. [PMID: 27865152 PMCID: PMC5183557 DOI: 10.1016/j.drugalcdep.2016.10.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The prevalence of psychoactive medications (PAMs) use in patients enrolled in Office Based Opioid Treatment (OBOT) and its association with engagement in this care is largely unknown. OBJECTIVE To describe the use of PAMs, including those medications with emerging evidence of misuse ("emerging PAMs" - gabapentin, clonidine and promethazine) among patients on buprenorphine, and its association with disengagement from OBOT. METHODS This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014. The association between use of PAMs and 6-month disengagement from OBOT was examined using multivariable logistic regression models. A secondary analysis exploring time-to-disengagement was conducted using Cox regression models. RESULTS At OBOT entry, 43% of patients (562/1308) were prescribed any PAM; including 17% (223/1308) on an emerging PAM. In separate adjusted analyses, neither the presence of any PAM (adjusted odds ratio [AOR] 1.07, 95% CI [0.78, 1.46]) nor an emerging PAM (AOR 1.28 [0.95, 1.74]) was significantly associated with 6-month disengagement. The results were similar for the Cox model (any PAM (adjusted hazard ratio [AHR] 1.16, 95% CI [1.00, 1.36]), emerging PAM (AHR 1.18 [0.98, 1.41])). Exploratory analyses suggested gabapentin (AHR 1.30 [1.05-1.62]) and clonidine (AHR 1.33 [1.01-1.73]) specifically, may be associated with an overall shorter time to disengagement. CONCLUSIONS Psychoactive medication use is common among patients in buprenorphine treatment. No significant association was found between the presence of any psychoactive medications, including medications with emerging evidence of misuse, and 6-month disengagement from buprenorphine treatment.
Collapse
Affiliation(s)
- Zoe M. Weinstein
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States
| | - Debbie M. Cheng
- Boston University School of Public Health, Department of Biostatistics, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States
| | - Emily Quinn
- Boston University School of Public Health, Data Coordinating Center, 85 East Newton St, M921, Boston, MA 02118, United States
| | - David Hui
- Boston University School of Medicine, 72 East Concord St. Boston, MA 02118, United States
| | - Hyunjoong Kim
- Boston University School of Medicine, 72 East Concord St. Boston, MA 02118, United States
| | - Gabriela Gryczynski
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States
| | - Jeffrey H. Samet
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States,Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Avenue, Boston, MA 02118, United States
| |
Collapse
|
17
|
Dahlman D, Abrahamsson T, Kral AH, Hakansson A. Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence. JOURNAL OF ADDICTION 2016; 2016:9298571. [PMID: 28097037 PMCID: PMC5206437 DOI: 10.1155/2016/9298571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/27/2016] [Indexed: 11/25/2022]
Abstract
Background. Nonmedical prescription drug use (NMPDU) is an increasing problem, insufficiently studied among people in opioid maintenance treatment (OMT). This study investigates the prevalence of and factors associated with NMPDU for drug classes insufficiently described in opioid-dependent populations, including antihistaminergic anxiolytics and central stimulants. Methods. Study participants were recruited at two OMT clinics in Malmo, Sweden, between October 2014 and December 2015 (N = 73) and interviewed about their use, motivations for use, and acquisition and administration of prescription drugs. Results. The majority of the sample reported lifetime NMPDU: 60% for benzodiazepine-like hypnotics (z-drugs), 21% for pregabalin, 19% for stimulants, and 12%-15% for antihistaminergic anxiolytics. Lower age was associated with nonmedical benzodiazepine use (Adjusted Odds Ratio = 0.89; 95% Confidence Interval = 0.82-0.97). Illicit acquisition was reported by 61% of people using z-drugs, 46% of people using pregabalin, and 38% of people using prescription stimulants, but only by 6-10% of people using antihistaminergic anxiolytics. Conclusions. The substantial nonmedical use of pregabalin, z-drugs, and prescription stimulants found in this study suggests that clinicians should prescribe these drugs with great caution. Nonmedical use of antihistaminergic anxiolytics does not seem to be a clinical issue among people in OMT in a Swedish setting, but we propose future studies to monitor their use.
Collapse
Affiliation(s)
- Disa Dahlman
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
| | - Tove Abrahamsson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
| | - Alex H. Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, CA, USA
| | - Anders Hakansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
| |
Collapse
|
18
|
|
19
|
Lim JK, Bratberg JP, Davis CS, Green TC, Walley AY. Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists. J Addict Med 2016; 10:300-8. [PMID: 27261669 PMCID: PMC5049966 DOI: 10.1097/adm.0000000000000223] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/07/2016] [Indexed: 01/23/2023]
Abstract
In March of 2015, the United States Department of Health and Human Services identified 3 priority areas to reduce opioid use disorders and overdose, which are as follows: opioid-prescribing practices; expanded use and distribution of naloxone; and expansion of medication-assisted treatment. In this narrative review of overdose prevention and the role of prescribers and pharmacists in distributing naloxone, we address these priority areas and present a clinical scenario within the review involving a pharmacist, a patient with chronic pain and anxiety, and a primary care physician. We also discuss current laws related to naloxone prescribing and dispensing. This review was adapted from the Prescribe to Prevent online continuing medical education module created for prescribers and pharmacists (http://www.opioidprescribing.com/naloxone_module_1-landing).
Collapse
Affiliation(s)
- Jamie K Lim
- Clinical Addiction Research and Education Unit (JKL, AYW), Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA; College of Pharmacy (JPB), University of Rhode Island, Kingston, RI; Network for Public Health Law (CSD), St. Paul, MN; Departments of Emergency Medicine and Epidemiology (TCG), Warren Alpert Medical School of Brown University, Providence, RI; and Department of Emergency Medicine (TCG), Boston University School of Medicine, Boston, MA
| | | | | | | | | |
Collapse
|
20
|
Vo KT, van Wijk XM, Lynch KL, Wu AH, Smollin CG. Counterfeit Norco Poisoning Outbreak — San Francisco Bay Area, California, March 25–April 5, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:420-3. [DOI: 10.15585/mmwr.mm6516e1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
21
|
Novak SP, Peiper NC, Zarkin GA. Nonmedical prescription pain reliever and alcohol consumption among cannabis users. Drug Alcohol Depend 2016; 159:101-8. [PMID: 26748409 PMCID: PMC4739852 DOI: 10.1016/j.drugalcdep.2015.11.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/21/2015] [Accepted: 11/28/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study examined poly-drug use involving the use of cannabis with nonmedical prescription pain reliever use (NMPR) and alcohol use. METHODS Computer-assisted survey data from the National Survey on Drug Use and Health were examined. The NSDUH is an annual, cross-sectional survey of non-institutionalized citizens in the United States (ages 12+). Replicate analyses were conducted using the 2013 and 2003 survey waves. RESULTS Higher levels of cannabis use were consistently associated with more frequent consumption of prescription pain relievers, with findings replicating in both 2013 and 2003. While the prevalence of dual users declined from 2003 (2.5%) to 2013 (2.3%), the average number of days used among dual users increased by an average of 20 days over that period. These changes largely occurred among those aged 35 or older, males, whites, and non-illicit drug users. Past-year marijuana use increased by 16% (10.8-12.6%, p-value<.001) whereas NMPR decreased by 15% (4.9-4.2%, p-value<.001). The largest changes occurred after 2011. Persons using the most cannabis generally had higher levels of alcohol use relative to those using the least amount of cannabis. There was a significant increase in the prevalence of dual use between 2003 (10.2%) and 2013 (11.6%), while the prevalence of past-year alcohol use remained relatively stable. CONCLUSIONS Clinical efforts and public health interventions should consider the possible co-ingestion of cannabis with NMPR and alcohol, as concomitant use may portend negative health effects in the short and long-term.
Collapse
Affiliation(s)
- Scott P Novak
- RTI International, Research Triangle Park, 3040 East Cornwallis Road, NC 27709, United States.
| | - Nicholas C Peiper
- RTI International, Research Triangle Park, 3040 East Cornwallis Road, NC 27709, United States.
| | - Gary A Zarkin
- RTI International, Research Triangle Park, 3040 East Cornwallis Road, NC 27709, United States.
| |
Collapse
|